Incoercible Vomiting in a Polycystic (ADPKD) Patient on Peritoneal Dialysis.

Although gastrointestinal symptoms are not uncommon in PD patients due to several causes, such as infusion volume with early satiety, constipation, or peritonitis, sometimes the differential diagnosis is more challenging for nephrologists. We present the case of a woman with end-stage renal disease due to autosomal dominant polycystic kidney disease on PD who presented with swollen legs and incoercible vomiting. After ruling out constipation and infection, an abdominal CT was done, revealing extrinsic compression of the intrahepatic inferior cava vein (ICV) and massive venous thrombosis from ICV to bilateral iliofemoral deep veins. In addition, CT also showed displacement and extrinsic compression of the stomach, pylorus, and duodenum due to an enlarged liver cyst. Percutaneous drainage and sclerosis of the cyst compressing the stomach was performed, anticoagulation was started, and the patient clinically improved with complete resolution of symptoms.

Vasculitis asociada a anticuerpos contra el citoplasma de neutrófilo con afectación renal: análisis de 89 casos / Anti-neutrophil cytoplasmic antibody-associated vasculitis with renal involvement: Analysis of 89 cases

Introducción: Las vasculitis con anticuerpos contra el citoplasma de neutrófilo con afectación renal se asocian con una elevada morbimortalidad. En este estudio se analiza si el pronóstico de estas vasculitis ha mejorado en los últimos años, y cuáles son los factores que condicionan su evolución. Material y métodos: Estudio retrospectivo de observación que incluyó a pacientes con poliangitis microscópica y granulomatosis con poliangitis con afectación renal diagnosticados en nuestro hospital durante los últimos 25 años. Se recogieron los parámetros demográficos, clínicos y bioquímicos de interés pronóstico, y se analizaron las diferencias según 4 períodos cronológicos, así como los determinantes de una peor evolución (muerte o insuficiencia renal terminal). Resultados: Se incluyeron 89 pacientes (edad media 64 ± 15 años). Sesenta y cuatro pacientes (72%) presentaban poliangitis microscópica y 25 (28%) granulomatosis con poliangitis. Durante el período de estudio, 37 (42%) pacientes fallecieron. Mediante análisis de regresión de Cox, los determinantes de mortalidad fueron el filtrado glomerular basal (HR 0,911; p = 0,003), índice de Charlson (HR 1,513; p < 0,0001) y exposición al tabaco (HR 1,816; p = 0,003). El 35% desarrolló insuficiencia renal terminal. Los mejores determinantes de este acontecimiento (en competencia de riesgo por muerte) fueron: filtrado glomerular basal (sub-hazard ratio [SHR]: 0,791; p < 0,0001), proteinuria (SHR: 1,313; p < 0,0001), y hábito tabaco (SHR: 1,848; p = 0,023). No se observaron diferencias en la supervivencia total o renal en los diferentes períodos estudiados. Conclusiones: El pronóstico de las vasculitis con anticuerpos contra el citoplasma de neutrófilo con afectación renal y tratamiento inmunosupresor convencional sigue siendo desfavorable, asociándose con numerosas complicaciones y elevada mortalidad (AU)

Introduction: The anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis with renal involvement are associated with high morbi-mortality. In this study we analyse if the prognosis of these diseases have improved in recent years, and which factors influence the outcomes. Material and methods: Retrospective single-centre observational study, which included all patients diagnosed with microscopic polyangiitis and granulomatosis with polyangiitis with renal involvement in the last 25 years. Demographic, clinical and biochemical parameters of prognostic interest were recorded. The differences between four chronological periods were analysed, along with the determinants of a poor outcome (death or end-stage renal disease). Results: Eighty-nine patients were included (mean age 64 ± 15 years). Sixty-four patients (72%) had microscopic polyangiitis and 25 (28%) granulomatosis with polyangiitis.During the study period, 37 (42%) patients died. Through Cox regression analysis, the best determinants of mortality were the initial glomerular filtration rate (HR 0.911; P = .003), Charlson comorbidity index (HR 1.513; P < .0001) and tobacco smoking (HR 1.816; P = .003). 35% developed end-stage renal disease, and the best determinants (by competing-risk regression) were: initial glomerular filtration rate (sub-hazard ratio [SHR]: 0.791; P < .0001), proteinuria (SHR: 1.313; P < .0001), and smoking status (SHR: 1.848; P = .023). No differences were found in patients’ mortality or renal survival between the different study periods. Conclusions: Prognosis of anti-neutrophil cytoplasm antibodies vasculitis with renal involvement treated with conventional immunosuppressive therapy remains unsatisfactory, and continues to have increased long-term complications and mortality (AU)

Tratamiento de la deficiencia androgénica del enfermo dializado con suplementos de testosterona. Resultados preliminaries / Treatment of the testosterone deficiency in hemodialysis patients. Preliminary results

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An Unexpected Cause of Severe Hypokalemia.

We describe an unusual case of severe hypokalemia with electrocardiographic changes, due to licorice consumption, in a 15-year-old female student with no previous medical history. Prompt replacement of potassium and cessation of licorice ingestion resulted in a favourable outcome. We also discuss the pathophysiology and diagnosis, emphasizing the importance of a detailed anamnesis to rule out an often forgotten cause of hypokalemia as the licorice poisoning.

Modelo clínico predictivo y validación de bacteriemias por anaerobios (incluidas las bacteriemias polimicrobianas) / Clinic predictive model and validation of anaerobic bacteremias (including polymicrobial bacteremias)

Introducción Las bacteriemias por microorganismos anaerobios son poco frecuentes, no existiendo consenso sobre su predictibilidad clínica y la utilidad rutinaria de los medios de cultivo para anaerobios. El objetivo del estudio es crear y validar un modelo predictivo de bacteriemia por anaerobios. Métodos El modelo predictivo se realizó con 984 bacteriemias (45 anaerobios estrictos) durante 1985–86 y 1996–97. La validación durante 2005–06 con 320 bacteriemias. Resultados Los factores predictores de bacteriemia por anaerobios calculados en el análisis multivariante para la creación de un modelo estratificado con puntuaciones de 0–13 puntos (p) fueron: origen desconocido (OR: 3,46; IC 95%: 1,13–10,54) 3 p; origen abdominal y cutáneo (OR: 14,85; IC 95%: 6,37–34,62) 6 p; hipotensión (OR: 1,99; IC 95%: 0,98–4,04) 2 p; ausencia de manipulaciones vasculares (OR: 2,62; IC 95%: 1,04–6,60) 2 p y edad >60 años (OR: 3,21; IC 95%: 1,19–8,67) 3 p. Con >7 p el modelo tiene S:77,8%, E:78,3%, VPP: 14,7% y un VPN del 98,6%, área bajo curva ROC=0,84 (EE=0,011). IC 95%: 0,82–0,86 con prevalencia de bacteriemia por anaerobios estimada 4,6%. La validación del modelo se realizó con 320 bacteremias (55 de ellas por anaerobios estrictos). El 83,6% (IC 95%: 71,19–92,23) de las bacteriemias por anaerobios tienen >7 p, y el 72,7% tienen 9 p o más. El 26,4% (IC 95%: 21,2–32,15) de las bacteriemias por aerobios y aerobios-anaerobios facultativos tienen >7 p, y solo el 11,7% tienen 9 p o más.Área bajo curva ROC=0,82 (EE=0,02). IC 95%: 0,78–0,86. Prevalencia estimada 2%.ConclusionesEl origen abdominal y cutáneo OR 14,85; origen desconocido OR 3,46; hipotensión OR 1,99; ausencia de manipulaciones vasculares OR 2,62 y edad >60 años OR 3,21 permiten crear un modelo clínico predictivo de bacteriemia por anaerobios con alta S y E. Por su baja prevalencia la importancia del modelo radica en su altísimo valor predictivo negativo (AU)

Introduction Anaerobic bacteremias are uncommon. There is no agreement on their clinical predictability and the usefulness of anaerobic blood cultures. The objective of this study was to develop and validate a model for the prediction of anaerobic bacteremias. Method The developing model was created with 984 bacteremias (45 anaerobic bacteremias) during 1985–1986 and 1996–1997. The validation model was made with 320 bacteremias during 2005–2006.ResultsIndependent multivariate predictors of true anaerobic bacteremia were used to develop a model stratifying patients with scores of 0 to 13 points(p), which were: unknown focus OR 3.46 (CI: 1.13–10.54) 3 p; abdominal and skin focus OR 14.85 (CI: 6.37–34.62) 6p; hypotension OR 1.99 (CI: 0.98–4.04) 2p; absence of vascular manipulations OR 2.62 (CI: 1.04–6.60) 2p and age over 60 years OR 3.21 (CI: 1.19–8.67) 3p. In the derivation sets group with more than 7p the model had Sensitivity: 77.8%, Specificity: 78.3%, PPV:14.7%, and a NPV of 98.6%. The area under curve was ROC=0.84 (SE=0.011), 95% CI: 0.82–0.86 (..) (AU)

[Clinic predictive model and validation of anaerobic bacteremias (including polymicrobial bacteremias)]. / Modelo clínico predictivo y validación de bacteriemias por anaerobios (incluidas las bacteriemias polimicrobianas).

INTRODUCTION: Anaerobic bacteremias are uncommon. There is no agreement on their clinical predictability and the usefulness of anaerobic blood cultures. The objective of this study was to develop and validate a model for the prediction of anaerobic bacteremias. METHOD: The developing model was created with 984 bacteremias (45 anaerobic bacteremias) during 1985-1986 and 1996-1997. The validation model was made with 320 bacteremias during 2005-2006. RESULTS: Independent multivariate predictors of true anaerobic bacteremia were used to develop a model stratifying patients with scores of 0 to 13 points(p), which were: unknown focus OR 3.46 (CI: 1.13-10.54) 3 p; abdominal and skin focus OR 14.85 (CI: 6.37-34.62) 6p; hypotension OR 1.99 (CI: 0.98-4.04) 2p; absence of vascular manipulations OR 2.62 (CI: 1.04-6.60) 2p and age over 60 years OR 3.21 (CI: 1.19-8.67) 3p. In the derivation sets group with more than 7p the model had Sensitivity: 77.8%, Specificity: 78.3%, PPV:14.7%, and a NPV of 98.6%. The area under curve was ROC=0.84 (SE=0.011), 95% CI: 0.82-0.86 with an anaerobic bacteremia prevalence of 4.6%. The validation set was studied analysing 320 bacteremias. Of these, 83.6% (95% CI: 71.19%-92.23%) of anaerobic bacteremias had more than 7 points, and 72.7% had more than 9 points. There was 26.4% (95% CI: 21.2%-32.15%) aerobic and facultative anaerobic bacteremias with more than 7 points, and only the 11.7% with 9 or more points. The area under the curve was, ROC=0.82 (SE=0.02), 95% CI:0.78-0.86, and estimated prevalence, 2%. CONCLUSIONS: Abdominal and skin focus OR 14,85; unknown focus OR 3,46; hypotension OR 1,99; absence of vascular manipulations OR 2,62 and age over 60 years enable us to make a predictive clinical model of probability of anaerobic bacteremia with a high sensitivity and specificity. The model particularly has a significant predictive negative value due to the low prevalence of anaerobic bacteremia.